Trauma, pressure sores, burns and other injuries often lead to skin defects at the injured site, accompanied by bone and tendon tissue exposure, infection and necrosis. Studies have shown that effective covering of the wound is the decisive factor in the treatment of the defect of the extremities [Citation1]. In the past, free skin flap and other operations were needed to repair the injured wound surface, but this often led to secondary damage, scar hyperplasia, and dysfunction of the donor skin area. In addition, the transplanted flap is prone to infection and necrosis.
In recent years, the application of Pelnac® artificial dermis in clinical wound defect repair has avoided the postoperative complications of conventional free flap repair and gradually showed more and more obvious advantages. The Pelnac® artificial dermis are processed from the extremely low antigenicity apoptotic collagen extracted from pig tendons and have good affinity with human tissues [Citation2]. It has a double-layer structure, with a silica gel membrane on the top, which can isolate bacteria to protect the wound surface and prevent excessive loss of water on the wound surface. The collagen sponge on the bottom is a three-dimensional scaffold structure with a porous structure with a pore diameter of 70–110 μm. The growth of cells promotes the formation of granulation tissue, and collagen is gradually degraded and absorbed by collagenase and replaced by dermal tissue [Citation3]. After 2 to 3 weeks, silica gel film was removed, and according to the growth of granulation tissue and the size of wound, it was decided whether to carry out self-thin epidermal grafting.
The author used VSD combined with Pelnac® artificial dermis to treat bone and tendon exposure at foot and ankle [Citation4]. The results showed that most patients had good prognosis effect, and no adverse postoperative complications such as infection, hematoma, seroma, skin graft failure were found. Only one patient developed postoperative scar contracture and was cured after treatment. Meanwhile, the author expounds the advantages of Pelnac® artificial dermis, from which we can see its application value, which is worth popularizing.
During the surgery, we must pay attention to the following points: 1. Thorough debridement and adequate hemostasis, if the wound is deep into the bone cortex, the necrotic cortex and broken bone should be removed until fresh bleeding occurs; 2. Using disinfectant to wet the wound surface for a period of time; 3. The artificial dermis must be fully attached to the base; 4. Bandaging with appropriate pressure; 5. Changing wound dressing regularly and using antibiotics after operation; 6. The negative pressure drainage of VSD should be unobstructed to avoid air leakage and pipe blockage.
In Xie’s study [Citation5], adenovirus vector targeting VEGF gene was transfected into human fibroblasts and transplanted into nude mice after inoculation with artificial dermis. It was observed that the high expression of VEGF induced by gene modification significantly promoted the vascularization process of the skin substitute and improved the survival rate of the graft. This research provides a broader research direction for us to better use artificial dermis such as leather Nike in the future. This is a field that has not yet been studied in large sample experiments and clinical studies, and it needs to be explored by future researchers and clinicians.
Declaration of Interest
The author reports no conflicts of interest. The author alone is responsible for the content and writing of the article.
References
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- Suzuki S, Kawai K, Ashoori F, Morimoto N, Nishimura Y, Ikada Y. Long-term follow-up study of artificial dermis composed of outer silicone layer and inner collagen sponge. Br J Plast Surg. 2000;53(8):659–666.
- Eo S, Kim Y, Cho S. Vacuum-assisted closure improves the incorporation of artificial dermis in soft tissue defects: Terudermis® and Pelnac®. Int Wound J. 2011;8(3):261–267.
- Zhenmu L, Qiusheng W, Rui J, Wenyuan D, Yong S. Pelnac® artificial dermis assisted by VSD for treatment of complex wound with bone/tendon exposed at the foot and ankle, a prospective study. J Invest Surg. 2018;33(7):636–641.
- Xie WG, Lindenmaier W, Gryzybowski S, Machens HG. Influence of vascular endothelial growth factor gene modification on skin substitute grafted on nude mice. Chin J Burns. 2005;21(3):203–206.